Hospital Looks At Safety Procedures

Parkway Regional Medical Center is reviewing its safety procedures in the wake of the shooting death of psychiatrist Christina Gabriele Smith inside a secure, 35-bed psychiatric unit.

``The patients are searched as they're brought in,'' Stephen Patz, Parkway's chief executive officer, said on Friday. ``We do a frisk of their person, their clothing and the bags they bring in. That's standard medical procedure.''

As it is at most psychiatric units.

But something went terribly wrong at the North Miami Beach hospital. Investigators are still trying to discover how suspect Knollys Sterling, a patient with a violent history, could have smuggled a gun into the seventh-floor unit.

Police said Sterling apparently was allowed to leave the hospital to visit his Southwest Miami-Dade home, then came back to the facility. Patz denied Sterling left.

Patz said the hospital has a procedure for dealing with dangerous patients. They are put in a special room that can be locked from the outside and has windows that allow close observation.

Police must lock their guns in a box before going into the unit, which is reached by elevators and has conference rooms.

Access to the security area requires a card with an electronic code, or someone from the nurses' station must buzz a visitor in.

Patz said visitors are screened, including family members, but they are not frisked, he said.

Bey Sedaget, president of U.S. Security based in Miami, said his company has security guards throughout the hospital, from the parking lot to the lobby to the psychiatric unit.

The use of metal detectors to screen visitors would be unmanageable, Sedaget said.

``There are no metal detectors in any hospital that I know of in the state of Florida, including Jackson Memorial,'' he said. ``It's not something you can do. You would stop a hospital from functioning.''

But a colleague and friend of Smith's disagreed, and offered an alternative.

``It's wrong that units that take violent offenders don't have hand-held metal detectors,'' said Dr. Carol Weingrod, a Miami psychiatrist. ``That somebody got into that unit with a gun just shouldn't happen.''

Weingrod said when she worked at a Boston psychiatric center a few years ago, the hand-held detectors were used on anyone entering the unit.

Weingrod said Smith took patients most other psychiatrists were afraid to treat, and those kinds of patients require extra precautions.

``Chris worked at a community mental health center in Miami that took patients from the court system, people who did violent crimes, but people who were thought to be manageable,'' Weingrod said. ``She hospitalized them, got them under control, adjusted their medication, and then made sure they got follow-up treatment in the community.''

Sterling had been ordered to the hospital for inpatient treatment after he stopped attending outpatient treatment sessions the judge had ordered earlier, police said.

According to the American Psychiatric Association, statistics on fatal assaults by psychiatric patients upon their doctors do not exist, but such deaths have occurred, including one at a Florida state hospital in 1986. The report did not name the hospital but said a patient came back six weeks after discharge with a shotgun, asked for the doctor, then shot him.

A report compiled by an APA task force in 1992 said that 40 percent of psychiatrists and other mental health care workers are assaulted by patients at some time during their careers.

Ann Schimmel, a Boca Raton psychiatric nurse, said she left her profession after an attack by a patient five years ago at Fair Oaks Hospital in Delray Beach.

The patient struck her in the face with a radio, broke her nose and injured her neck. She was knocked unconscious and was unable to work for two years, Schimmel said.

``I have not worked, because the reality is I'm a psychiatric nurse, and a psychiatric hospital is an unsafe environment. How is a gun permitted in a hospital?''

Pat McCarthy, a spokesperson for Fair Oaks, said employees receive initial training in crisis prevention and annual refresher courses on what to do should a patient become aggressive.

She said all patients' belongings are searched upon admission.

Mental health advocates and psychiatrists said Friday that Smith's death should not have happened, but the vast majority of mental patients pose no threat to their therapists.

``In my 20 years of experience, I have never seen anything like this,'' Sedaget said. ``This kind of thing you just can't guard against. It's a tragedy. My condolences go out to the doctor's family.''

``This was a rare, freaky-type occurrence,'' said Dr. David M. Tobolowsky, president of the South Florida Psychiatric Society. ``I haven't heard of any other such deaths in all the time I've been practicing.''

Howard Finkelstein, a Broward public defender who defends mentally ill people charged with crimes, said most people with mental illness pose no danger to their doctors or the public.

``My greatest fear is that people will react to this shooting and unfairly project this behavior on other mentally ill people,'' Finkelstein said. ``The vast majority of mentally ill people are harmless and passive. If they are a threat, it's usually to themselves.''